Polypharmacy and potentially inappropriate prescribing in people with type 2 diabetes: An analysis of the Scottish Diabetes Research Network national diabetes cohort

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AIMS: This study assesses national trends and, socio-demographic and clinical factors associated with polypharmacy and potentially in appropriate prescribing among people with type 2 diabetes in Scotland from 2012 to 2022. METHODS: Retrospective cohort study using nationwide data from the Scottish Care Information - Diabetes database. Individuals aged ≥40 years with type 2 diabetes were included. Medication counts were based on unique medications dispensed per calendar year. Potentially inappropriate medications were based on the 2023 Beers criteria and applied to people aged over 65 years. A Poisson mixed-effects model with individual-level random intercepts assessed the relationship between the number of drug classes dispensed and year, gender, age group and socio-economic status, Elixhauser comorbidity index and the hospital frailty risk score. RESULTS: 387,338 people were included. The median number of medications dispensed per person was 9 (interquartile range 5-13). Adjusted medication counts were modestly higher in older people (rate ratio [RR] 1.06, 95% confidence interval [CI] 1.06-1.06 at age 80+ compared to 40-59), higher in women (1.14, 1.13-1.14), in more deprived areas (1.24, 1.23-1.24 in the most deprived vs. the most affluent quintile) and in those with higher comorbidity (1.12, 1.12-1.13 in 4+ vs. 0 comorbidities) but not with high frailty risk (1.00, 1.00-1.00). People over 65 were dispensed a median of 2 (IQR 1-3) potentially inappropriate medications. Potentially inappropriate medication showed a stronger association with comorbidity (1.24, 1.23-1.25) and a positive association with high frailty risk (1.24, 1.23-1.25). CONCLUSIONS: The degree of polypharmacy highlights the need for regular formal medication reviews in this population.

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